Journal of Gerontological Nursing

WASHINGTON DIGEST 

HCFA Regulations for Nurse's Aides

Cheryl Pokalo

Abstract

As of April 1, facilities participating in the Medicare and Medicaid programs must ensure that nurse's aides have the proper education, practical knowledge, and skills to care for residents in compliance with regulations issued by the Health Care Financing Administration (HCFA). States are now required to establish registries of nurse's aides who have completed certification examinations.

In general, facilities cannot employ nurse's aides for longer than 4 months unless they have demonstrated competency in providing nursing care and have completed a training and competency evaluation program, or a state-approved competency evaluation program. Anyone who has not worked in nursing for 24 consecutive months must be retrained, and the facility must provide at least 12 hours of inservice education per year.

Nurse's aides have the option of taking the competency evaluation at the facility at which they are employed, and they may choose either a written or oral examination. In addition to the examination, nurse's aides must demonstrate randomly selected items drawn from a pool of tasks generally performed by nurse's aides. Individuals who successfully complete the examination will automatically be entered on the registry; those who fail have at least three attempts to successfully complete it.

The HCFA has specified what should be included in the nurse's aide training curriculum:

* At least 16 hours of training in direct resident care, for example, communication and interpersonal skills; infection control; safety and emergency procedures; promoting residents' independence; and respecting residents' rights.

* Basic nursing skills, for example, taking and recording vital signs; measuring and recording height and weight; caring for the residents' environment; recognizing abnormal changes in body functioning and reporting those changes to a supervisor; and caring for residents near death.

* Personal care skills, for example, bathing; grooming; dressing; toileting; proper feeding techniques; assisting with eating and hydration; skin care; and transfers, positioning, and turning.

* Mental health and social service needs, for example, modifying behavior in response to a resident's behavior; awareness of developmental tasks associated with aging; responding properly to residents' behavior; allowing the resident to make personal choices; providing and reinforcing behavior consistent with the resident's dignity; and using the resident's family as a source of emotional support.

* Basic restorative services, such as training the resident in self-care; using assistive devices in transferring, ambulation, eating, and dressing; mamtaining range of motion; proper turning and positioning in bed and chair; bowel and bladder training; and care and use of prosthetic and orthotic devices.

* Residents' rights, for example, providing privacy and maintaining confidentiality; promoting the resident's right to make personal choices; assisting in resolving grievances and disputes; assisting residents in getting to and participating in activities; securing the resident's personal possessions; promoting the resident's right to be free from abuse, mistreatment, and neglect, as well as the need to report such incidents; and avoiding the use of restraints.

The registry must include the individual's full name, enough information to identify the individual, and the date on which a competency evaluation program was completed. Any findings of abuse, neglect, or misappropriation of property by the individual must be included. The nature of the allegation, evidence, and documentation of the state's investigation must be included, as well as the date and outcome of any hearings and a statement by the individual.

This information must remain in the registry permanently unless the information was erroneously reported or the individual is found not guilty in a court of law. Individuals must be notified promptly of such adverse information and given a sufficient opportunity to respond.

Facilities must receive registry verification that individuals have met the competency requirements before employing them…

As of April 1, facilities participating in the Medicare and Medicaid programs must ensure that nurse's aides have the proper education, practical knowledge, and skills to care for residents in compliance with regulations issued by the Health Care Financing Administration (HCFA). States are now required to establish registries of nurse's aides who have completed certification examinations.

In general, facilities cannot employ nurse's aides for longer than 4 months unless they have demonstrated competency in providing nursing care and have completed a training and competency evaluation program, or a state-approved competency evaluation program. Anyone who has not worked in nursing for 24 consecutive months must be retrained, and the facility must provide at least 12 hours of inservice education per year.

Nurse's aides have the option of taking the competency evaluation at the facility at which they are employed, and they may choose either a written or oral examination. In addition to the examination, nurse's aides must demonstrate randomly selected items drawn from a pool of tasks generally performed by nurse's aides. Individuals who successfully complete the examination will automatically be entered on the registry; those who fail have at least three attempts to successfully complete it.

The HCFA has specified what should be included in the nurse's aide training curriculum:

* At least 16 hours of training in direct resident care, for example, communication and interpersonal skills; infection control; safety and emergency procedures; promoting residents' independence; and respecting residents' rights.

* Basic nursing skills, for example, taking and recording vital signs; measuring and recording height and weight; caring for the residents' environment; recognizing abnormal changes in body functioning and reporting those changes to a supervisor; and caring for residents near death.

* Personal care skills, for example, bathing; grooming; dressing; toileting; proper feeding techniques; assisting with eating and hydration; skin care; and transfers, positioning, and turning.

* Mental health and social service needs, for example, modifying behavior in response to a resident's behavior; awareness of developmental tasks associated with aging; responding properly to residents' behavior; allowing the resident to make personal choices; providing and reinforcing behavior consistent with the resident's dignity; and using the resident's family as a source of emotional support.

* Basic restorative services, such as training the resident in self-care; using assistive devices in transferring, ambulation, eating, and dressing; mamtaining range of motion; proper turning and positioning in bed and chair; bowel and bladder training; and care and use of prosthetic and orthotic devices.

* Residents' rights, for example, providing privacy and maintaining confidentiality; promoting the resident's right to make personal choices; assisting in resolving grievances and disputes; assisting residents in getting to and participating in activities; securing the resident's personal possessions; promoting the resident's right to be free from abuse, mistreatment, and neglect, as well as the need to report such incidents; and avoiding the use of restraints.

The registry must include the individual's full name, enough information to identify the individual, and the date on which a competency evaluation program was completed. Any findings of abuse, neglect, or misappropriation of property by the individual must be included. The nature of the allegation, evidence, and documentation of the state's investigation must be included, as well as the date and outcome of any hearings and a statement by the individual.

This information must remain in the registry permanently unless the information was erroneously reported or the individual is found not guilty in a court of law. Individuals must be notified promptly of such adverse information and given a sufficient opportunity to respond.

Facilities must receive registry verification that individuals have met the competency requirements before employing them as nurse's aides. Facilities must also check the registries of all other states that it believes may have information about the individual.

For more information, contact Martha Kuespert, Health Care Financing Administration, 301-966-1782.

Cheryl Pokab

10.3928/0098-9134-19920801-11

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